A Matter of Sight

Wednesday

Jan 14, 2009 at 12:01 AM

By RODA GRUBB

Something was happening. No longer were items crystal clear in her sight. In fact - her distant sight had become a great big fuzz. Even cleaning her glasses over and over would not take the smudge out of her vision. On her next visit to her optometrist she was given the diagnosis: cataract.

“It can’t be,” she thought to herself. “I’m only in my 50s.”

“Cataracts can start at different times in different people,” said Dr. Douglas Koch, professor and the Allen, Mosbacher, and Law Chair in Ophthalmology at the Cullen Eye Institute, Baylor College of Medicine. “For a small minority, they may be genetic, caused by eye injuries or certain diseases such as diabetes. Environmental reasons, such as prolonged exposure to ultra violet light can contribute to cataract formation. However, the great majority are simply caused by chemical changes in the lens that partially result from the normal process of aging.

“A cataract is not a tumor or growth of new tissue over or in the eye. Rather, it is a fogging and loss of clarity of the lens itself,” Koch said. “The lens is located in the eye just behind the iris and pupil. Light entering the eye is focused by the lens onto the retina. When a cataract forms, the lens is no longer able to focus the light clearly.”

For the woman, her vision change was so subtle over the years she was surprised when she realized she no longer could read street signs, with or without her glasses. Changing the text size on her computer gradually from small to medium to large, she still needed to almost sit on top of the computer in order to see the text.

Finally, coming to the realization something had to be done, after futilely trying every kind of alternative health eye drops she could find, she made an appointment with the ophthalmologist. Though there are no medicines to prevent cataracts, Koch said there are some things one can do.

“If you’re outside a lot, wear sunglasses with an ultraviolet filter. Wear a hat with a brim. We know if you’re malnourished you’re more at risk for cataract formation,” said Koch. “However, the literature has been pretty disappointing about any evidence that taking this or that vitamin might prevent cataracts. Some studies say yes, other studies say no.

“I tell my patients the smart thing to do for eye health in general is to have a healthy diet. Eat lots of leafy green vegetables and fruits that are high in antioxidants. I recommend that all my patients take fish oil. There’s some evidence that the antioxidant effect of the Omega 3 fatty acids is protective of the retina for macula degeneration - at least to a modest amount. It probably is good to take a multivitamin. Just be sure that one’s vitamin intake is balanced,” he said. “Beyond that it’s kind of out of your hands.”

Dr. Koch grew up in a small town in Michigan.

“My father was a physician. One of his closest friends was an ophthalmologist who was actually a world famous ophthalmologist despite being located in this little town. This ophthalmologist developed one of the first devices for removing the vitreous gel from the back of the eye,” said Koch. “He had doctors from all over the world come to Port Huron, Michigan, to observe his surgery and go to his home.

“When I was about 8, I was diagnosed with nearsightedness myself. I started wearing glasses and then I moved to contact lens. I quickly began to appreciate how important it was to have good vision. This link plus this good family friend, who was so remarkable, was sort of the first thing that peaked my interest.

“That said, I went through medical school and loved many of the fields I was studying. Near the end of my third year of medical school, I finally had a chance to take an ophthalmology rotation. When I really sat down and started looking at the human eye, saw how beautiful it was and how much we have the potential to help it, I said, ‘That is it. I have to do this,’” he said with enthusiasm.

Having been informed with all the facts of the different options she had, they chose from the five options (see sidebar) - a single vision (monofocal) lens for near vision and an appointment was set for the surgery.

After the pre-surgery tests to clarify the final adjustments for her new lens, the woman arrived early the next morning for the surgery. She was tucked tightly in cocoon fashion in warm blankets as the light anesthesia took effect. When she next realized her surroundings, the darkened room was lit only by the fuzzy light in front of her eye.

“What’s that chicklet looking thing?” she asked of the tiny, white rectangles she saw.

“The microscope,” said a smiling voice which she recognized as the doctor’s.

She had no physical sensation from the surgery and felt safe and cozy in her warm wrap. Before she knew it she was in recovery. A short time later she was dressed and meeting with the doctor who was telling her and her husband all went well.

With an eye shield in place and armed with a kit full of drops they left. Peering through the patch she found she could see clearly. As her husband drove home she eagerly read aloud everything she saw - building signs, billboards, street signs, license plates. How miraculous it all seemed to her.

Two days later her eye looked totally normal - no redness and no sign of the traumatic event it had just gone through.

Within six weeks her eye was back to normal - all swelling gone. Having selected the nearsighted lens, new glasses gave her the vision she had lacked for the last few years.

“The whole goal is to make the surgery seem as comfortable and pain free and a-traumatic as possible,” said the doctor who had developed some of the very instruments used in the procedure.

Thinking back over the last weeks - the surgery and recovery - she smiled as she looked out into a clearly defined world. Without a doubt she felt she could honestly pronounce it as a … Mission Accomplished!